Medicine suffers from a culture of silence
I am a resident in a fancy hospital in New York. We focus a lot on value-based care, and technological innovations, and high reliability. This year, we are opening a multimillion-dollar new facility for specialty medical services. Our outdoor spaces have stone lions and grassy promenades. Our cafe serves world-class food.
Today, during a beautiful new spring morning, I watched my colleagues sit, in disbelief and despair, crying with each other or amongst themselves, in our beautiful courtyards. Someone we knew died today, potentially by her own hand.
Our leadership talks about wellness, and burnout, and resiliency in resid...
Source: Kevin, M.D. - Medical Weblog - May 8, 2018 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/anonymous" rel="tag" > Anonymous < /a > Tags: Physician Hospital-Based Medicine Psychiatry Source Type: blogs
Is There a Delayed Activation Wave???
This 50-something otherwise healthy male presented with one hour of epigastric and lower chest pain.Here is his initial ECG:What do you think?The QRS is 90 ms and the QTc is 400 ms.There is ST Elevation (STE) in II, III, aVF, with reciprocal ST depression in aVL. There is also ST depression in V2 and V3. V2 and V3 almost always have some amount of normal ST elevation, and since posterior MI is associated with inferior MI, you must make notice of this and think it is probably an inferior posterior MI.However, II, III, and aVF have what appear to be J-waves at the end of the QRS. If these are J-waves, then ...
Source: Dr. Smith's ECG Blog - May 6, 2018 Category: Cardiology Authors: Steve Smith Source Type: blogs
This surgeon changed his mind about having more support
I was in my surgical residency back in the days of “you can go home when the work is done.” A few years before I arrived as an intern, one of my attending surgeons had decided he was going to jump on the trauma train. Trauma was in its infancy back then, and he was convinced (and rightly so) that patients could be greatly helped with this relatively new concept of the “golden hour.” I remember hearing stories of him taking a trip to Baltimore’s Shock Trauma Center, and when he returned he was full of great ideas. He designed an incredible system for our program including three helicopters and ...
Source: Kevin, M.D. - Medical Weblog - May 1, 2018 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/dave-redd" rel="tag" > Dave Redd, MD < /a > Tags: Physician Surgery Source Type: blogs
Has patient-centered care gone too far?
The first week of residency of any program is usually comprised of several orientation sessions in which the new interns are introduced to various important aspects of the residency program. My orientation week was no different with a river of new information flowing towards me. Needless to say, I felt a bit overwhelmed and struggled to keep track of everything that was being introduced. Later on, I found out that this was true for all of my colleagues, that made me feel a little better about myself.
One of the sessions regarding patient safety and quality though caught my eye. It was the introduction of the STEEEP model o...
Source: Kevin, M.D. - Medical Weblog - April 28, 2018 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/ali-rafiq" rel="tag" > Ali Rafiq, MD < /a > Tags: Physician Hospital-Based Medicine Primary Care Residency Source Type: blogs
Tips for IM Attendings – Chapter 22 – take a mental break
We present sitting, and it usually takes 2 full hours to hear 8 patients (and that means going quite fast at times). Those 15 minutes are gold. Almost all residents and interns are very grateful. But I am also grateful. I take that time to walk downstairs to get a drink. I chat with the students or house staff, depending on the day. When we start back we are refreshed and (I believe) more productive.
Breaks are healthy. Talking about non-medical issues is healthy.
So think about how you can take a mental break (and perhaps even a physical break) during rounds. You and your learners will benefit, and therefo...
Source: DB's Medical Rants - April 11, 2018 Category: Internal Medicine Authors: rcentor Tags: Medical Rants Source Type: blogs
Should we encourage people to go into medicine?
Recently, a brilliant, caring and warm-hearted friend of mine approached me asking if I would help her with MCAT studying. She’d be a non-traditional medical school applicant due to a few gap years. Thus, she needed to prove to herself and prospective schools she still had the academic chops.
Immediately, I froze.
Over the years, I have served as mentor to medical students, interns, and residents. To be there at someone’s aha moment has always been something I’ve enjoyed, and the thought of paying it forward in homage to my mentors leaves me utterly sentimental. We’ve created a supportive community — ...
Source: Kevin, M.D. - Medical Weblog - April 3, 2018 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/millennial-doctor" rel="tag" > Millennial Doctor, MD < /a > Tags: Education Medical school Source Type: blogs
Prepping intern notes
I received a wonderful tweet based on my nouns need adjectives post.
I’m prepping materials for incoming interns inspired in part by this. Focus is on notes for our inpatient service. Got anything to add?
The idea is to list common chronic problems and specify information that an admission note should include. Here are my thoughts including his suggestions and my modifications
COPD – PFTs if done, current meds, home oxygen?, possibly Gold Stage
Heart failure – systolic function, define type of heart failure, any valvular disease, current meds, if EF < 35% does patient have AICD, EKG – does t...
Source: DB's Medical Rants - March 23, 2018 Category: Internal Medicine Authors: rcentor Tags: Medical Rants Source Type: blogs
Hypotensive and Tachycardic in Clinic: A Quick Ticket to the ED and Lewis Leads
This was contributed by one of our fine interns,Aaron Robinson.A 40-something male cancer patient presented to clinic for a routine follow up and stated he was feeling “tired.” He was just finishing a course of antibiotics for bacteremia. His BP was found to be 60 systolic with a heart rate in the 170s. He was moved to the Emergency Department.He appeared ill, but was not acutely in distress. He showed signs of volume depletion.His initial ECG is shown below. What do you see?Initial ECG: This is a regular narrow complex tachycardia at a rate of 157 BPM. There is no obvious atrial activity prior to the Q...
Source: Dr. Smith's ECG Blog - March 20, 2018 Category: Cardiology Authors: Steve Smith Source Type: blogs
That Darned Foreskin
I was a practicing pediatrician before I did a residency in emergency medicine. One of the most common and sometimes most stressful decisions parents had to make in the neonatal nursery was whether to circumcise their newborn son. I have to admit that the hullabaloo about the foreskin has always intrigued me. The American Academy of Pediatrics has gone back and forth over the years on the topic of circumcision and its benefits, but the current evidence clearly establishes a benefit from this procedure (Pediatrics 2012;130[3]:e756) that is performed approximately 1.4 million times each year in the United States. (May...
Source: M2E Too! Mellick's Multimedia EduBlog - February 28, 2018 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Hiring a new librarian? Are new graduates qualified?
Believe it or not some librarians are retiring and some libraries are hiring. I know, I heard the same story 20 yrs. ago in library school about the wave of librarians retiring and the need to hire a bunch of librarians to fill those open positions. Instead of a giant wave of retirements, I think it has been a gentle rise over time. Instead of filling every single open position retirement brought, I think there has been closing of libraries, not filling positions, or restructuring positions for a different type of fill. However, not all positions will be left unfilled. I know of a library that will probably have at...
Source: The Krafty Librarian - February 22, 2018 Category: Databases & Libraries Authors: KraftyLibrarian Tags: Uncategorized Source Type: blogs
What physicians what their patients to know: 13 more things
After reading “13 things every doctor wants their patients to know,” here are 13 more things good doctors wish their patients knew.
1. We need the complete truth. I feel for patients who hesitate to reveal something embarrassing. But we hear so much. Very little shocks us. Also, we realize we haven’t walked a mile in your shoes. Or an inch. We take in the facts and get down to the work of helping you. But we need the straight truth. This means telling us what drugs you’ve taken, legal and illegal, to avoid drug interactions. Or telling us exactly when you last ate before surgery to minimize pneumonia risk...
Source: Kevin, M.D. - Medical Weblog - February 5, 2018 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/joanne-jarrett" rel="tag" > Joanne Jarrett, MD < /a > Tags: Physician Primary Care Source Type: blogs
To Err is Homicide in Britain – the case of Dr. Hadiza Bawa-Garba
By, SAURABH JHA
The good that doctors do is oft interred by a single error. The case of Dr. Hadiza Bawa-Garba, a trainee pediatrician in the NHS, convicted for homicide for the death of a child from sepsis, and hounded by the General Medical Council, is every junior doctor’s primal fear.
An atypical Friday
Though far from usual, Friday February 18th, 2011 was not a typically unusual day in a British hospital. Dr. Bawa-Garba had just returned from a thirteen-month maternity break. She was the on-call pediatric registrar – the second in command for the care of sick children at Leicester Royal Infirmary. As a “r...
Source: The Health Care Blog - January 30, 2018 Category: Consumer Health News Authors: at RogueRad Tags: Patients Physicians The Business of Health Care Source Type: blogs
Why I love inpatient IM ward attending
38 years and I still get excited making rounds. 45 years ago I discovered that I was meant to be an internist – it was my first week on the IM rotation. Prior to that week I had no idea!
Internal medicine combines understanding medical science and people. Internal medicine requires detective work and compassion. Internal medicine typifies what I thought of as I thought of being physician.
Practicing internal medicine is honorable. One need not do more than that to contribute to patients. But from my student years the teaching of internal medicine attracted me.
I remember being an intern and wanting to hel...
Source: DB's Medical Rants - January 28, 2018 Category: Internal Medicine Authors: rcentor Tags: Medical Rants Source Type: blogs
Is this ECG diagnostic of coronary occlusion? Also: Inferior de Winter's T-waves on prehospital ECG??
This post was written by one ofour fantastic Hennepin County Medical Center Emergency Medicine interns who is an ECG whiz, Daniel Lee.A man is his late 50 ’s presents to the ED with 1 hour of post exertional chest pressure associated with diaphoresis and nausea. He has a history of known CAD, diabetes, and dyslipidemia.By pure clinical appearance, he looked like the textbook patient with acute MI.This is his first ECG in the department, which I saw as it was being printed:What do you think?Here is a previous baseline ECG from 3 years prior to compare:This was my interpretation of the first ECG:Sinus bradycardia wit...
Source: Dr. Smith's ECG Blog - January 28, 2018 Category: Cardiology Authors: Steve Smith Source Type: blogs
A Marriage Counselor Gets Personal
I think I was put on earth to write about marriage. But no one who knew me when I was single would have guessed it. After a couple of decades of looking for the one and meeting many men, I finally married. At my wedding, a friend said, “It’s the end of an era.”
Long before becoming a wife, I was a marriage expert — for other people. A licensed clinical social worker, marriage counselor and psychotherapist, I helped couples transform their relationships. My clients helped me too, probably without knowing it.
During a session with a husband and wife I saw for couple therapy for some time, they said I must thin...
Source: World of Psychology - January 24, 2018 Category: Psychiatry & Psychology Authors: Marcia Naomi Berger, MSW, LCSW Tags: Books Communication Marriage and Divorce Personal Relationships Treatment Commitment Dating Fear Of Abandonment Heartache Intimacy Love Mentorship Source Type: blogs
